Adult Medicine Whidden Teaching Service

Whidden Memorial houses our primary inpatient teaching service. This busy community hospital serves the 200,000 residents of Everett, Revere, Chelsea, Winthrop, and Malden. We are the only hospital in this five-city area and are proud to provide high-quality health care to people from the entire metro-North region. Given the extremely diverse and under-served population in this region we see an incredible breadth of pathology including rare tropical diseases from our robust recent immigrant population. As the only resident service in the hospital our team is on the front lines without distraction or competition from other trainees.

The inpatient team is comprised of a third year, a second year and two first year family medicine residents. To optimize the balance of inpatient and outpatient teaching as well as protecting didactic time, we’ve build a night hospitalist float system. The service is attended by a dedicated faculty member who has no other responsibilities during that week to ensure the highest level of supervision, teaching and direct observation. To leverage our phenomenal teachers from both our own family medicine program as well as our stellar internal medicine colleagues (CHA also has a Harvard Affiliated Internal Medicine Residency Program) we alternate attendings weekly so each team gets to work with an internal medicine attending and a family medicine attending for each 2-week team cycle.

As innovators in family medicine education, our Whidden Teaching Service is part of a national pilot program that has developed “teach cards” that are designed to systematically incorporate high yield teaching topics and pearls directly into the daily “work rounds." In rounds teaching happens daily on the service further bolstered by weekly didactic teaching from a our own team and a wide range of our specialist colleagues. The team is equipped with laptops that have full wireless access throughout the hospital so they can seamlessly reference Epic (our electronic health record) as well as connect to a myriad of internet resources including the entire Tufts University School of Medicine Library during rounds and at the point of care. We practice what we preach having faculty who are international leaders in information mastery and evidence-based medicine, we bring that to life everyday in our clinical practice.

Community Medicine

The Community Medicine curriculum at Tufts University Family Medicine Residency will provide resident physicians with an understanding of the social, economic, and cultural contexts of health and an appreciation of the public health perspective on community well-being. The second year Community Medicine program includes a mix of didactic curriculum sessions as well as scheduled time for meetings with a community agency partner.

Didactic sessions focus on local public health statistics, social determinants of health and disease and the elements of a community health needs assessment. We’ll also visit local community agencies, participate in lectures by leaders of Malden community based organizations, and receive a lecture led by Malden High School students centered how to best deliver patient centered care to the youth population.

Practical sessions allow the residents to partner with a local agency to learn about their client population’s strengths and needs. Together the resident and agency will collaboratively build a project to help address a broadly-defined health need. Throughout the second year, the resident will work alongside the agency to carry out the project. The outcomes of the community health project will be presented at the Cambridge Health Alliance’s annual poster session. Beyond the second year, we also facilitate community medicine clinical electives for senior residents, focusing in areas such as healthcare for the homeless, addiction medicine, and teen health.

The Community Medicine curriculum at Tufts University Family Medicine Residency is responsive to the changing landscape of healthcare delivery. As the healthcare system evolves towards patient-centeredness, there is great value in understanding the greater context of where our patients live and work. This curriculum aims to give the resident exposure to the social determinants of health as well as the community agencies serving their needs.

Complementary and Alternative Medicine (CAM)

The Tufts FMR has been awarded a grant by the Weill Foundation which has enabled us to offer the the Integrated Medicine Residency, a rich 200 hour on-line program. Dr. Andrea Gordon, one of our core faculty has a fellowship in integrative medicine and as a resident you rotate with her in her Integrative Medicine clinics where you will learn broad approaches to many typically vexing disease processes. We also have Osteopaths on our faculty who teach osteopathic manipulation. New England School of Acupuncture also works out of our health center twice weekly to offer this valuable service at discounted rates to our patients. At Tufts FMR we believe that integrative medicine should be just that – integrated. So we strive to include teaching on integrative medicine techniques in all our didactics, and teach residents how to use it in their every day practice.

Elective Experiences

You can choose a wide variety of elective experiences for additional training in areas of interest to you. Residents are encouraged to take advantage of our Boston location and train in either community subspecialty office practices or at the many Boston teaching hospitals. Examples of electives residents have taken include family medicine electives in Mexico, Costa Rica and Belgium, an Obstetrics month in Los Angeles, a month at the Joslin Diabetes Center in Boston, and a Geriatrics month at Beth Israel Deaconess Medical Center in Boston. Many different international electives are also available, as are rural family medicine experiences.

Emergency Medicine

As a second year resident you will train at our Whidden campus, a busy suburban emergency department that averages more than 33,000 visits annually. Supervised by experienced emergency medicine physicians, you will be involved in the diagnosis and treatment of acute problems and emergencies. Basic and advanced life support prepare you for recognition, evaluation, and stabilization in code situations. Residents interested in more emergency room experience can elect to do an additional emergency medicine month at Whidden or a number of other Boston area hospitals. We also have a third year rotation at Winchester Pediatric Emergency Department where residents work one-on-one with Pediatric Emergency Physicians from Children’s Hospital, the top Children’s hospital in the world.

Evidence-Based Medicine

The Tufts University Family Medicine Residency at Cambridge Health Alliance is committed to teaching residents and medical students an evidence-based approach to practice. Our Information Mastery Curriculum will teach you not only how to find the best answer to clinic questions, but also prepare you to be life-long learners to stay current and at the top of the field in Family Medicine. You will learn how to quickly access information from multiple sources and become experts at critical analysis of the medical literature. We examine clinical practice guidelines to determine the best clinical practice of our specialty, and have bi-weekly MythBusters conference where we challenge common “medical myths” and clinical questions to see if they hold up to the best evidence available.

Family Medicine Center

The clinic is the curriculum” is one of our mantras here at Tufts FMR. We’ve designed our curriculum around the clinic to acknowledge that as family medicine physicians we are outpatient specialists and we believe the most of you residency experience should be in the family medicine center learning from other family physicians and staff. We are involved in numerous collaborative and projects to move us forward in primary care re-design and creation of a Patient Centered Medical Home. Each resident is assigned to a clinical team and serve as the family physician for a panel of patients at the CHA Malden Family Medicine Center, our new building at 195 Canal Street in Malden. Residents facilitate our clinical teams and are involved in group visits, dermatologic and women’s health procedure clinics as part of the family medicine center rotations.

Geriatrics

Care of the older person is an important focus of your training here. We have board certified geriatricians who are also family physicians, leading many of the didactics in this area and the experiences outside of the clinic. Home visits are part of the curriculum and often include elders. We attend patients at the Everett Nursing Home and Rehabilitation Center, and the Maplewood Assisted Living Center in Malden. Residents are required to develop longitudinal relationships with elders across the continuum of care: outpatient, inpatient, rehabilitation, home care, long term care, and all of our faculty are adept at teaching the skills needed. Elective time and more intensive training is available for those who chose geriatrics as their area of concentration. CHA has a robust Division of Geriatrics that is linked to both Beth Israel Deconess Medical Center and Harvard Medical School.

Gynecology and Reproductive Health

At Malden Family Medicine you will provide routine well woman, gynecologic and reproductive health care to your own patient panel. Additionally, you will learn colposcopy, endometrial sampling, IUD and Nexplanon insertion, and uterine aspiration in dedicated procedure sessions with family medicine faculty. You expand your knowledge through care of patients in community-based gynecologists' offices and will also participate in minor and major gynecologic surgery under the direction of a gynecologist.

We believe that reproductive health is core to wellness and that patients should be able to access family planning services from the doctor that knows them best. Contraceptive management, options counseling for unintended pregnancy, miscarriage management and early abortion care are taught at Malden Family Medicine. Procedural skills are taught by family medicine faculty at CHA, in a private family planning clinic and within the Department of Family Planning at Beth Israel Deaconess Medical Center.

Intensive Care Unit

This first year rotation at Tufts Medical Center in Boston is a concentrated month of training in intensive care medicine in a tertiary medical center environment, with superb subspecialty consultants and significant exposure to the resources of a top-rated tertiary medical center. This rotation provides residents an unusual breadth of ICU experience.

Medical Informatics

All residents receive an iPhone at entry into the residency. This device simplifies your life by serving as your cell phone and pager with all services paid by the department. Our Family Medicine Center uses EPIC, a state-of-the-art electronic medical record. You will learn how to use computers in your medical practice, to obtain patient information, use the internet, and to access notes from residency conferences, important telephone numbers, and medical texts. Besides regular conferences on medical informatics, computers are used daily throughout the hospital and family health center to rapidly access answers to clinical questions raised in the course of patient care.

Nursery/Neonatal Intensive Care Unit

This first year rotation is a good example of the utility of training in both a community hospital setting and a tertiary medical center. Residents become proficient at performing a normal newborn examination, manage common neonatal disorders such as hypoglycemia, feeding problems, TTN, and hyperbilirubinemia. They also become certified in the Neonatal Resuscitation course and attend resuscitations with neonatologists at Floating Hospital for Children at Tufts Medical Center.

Obstetrics

You will train in both our “home” community hospital at Cambridge Hospital as well as Beth Israel Deaconess Medical Center, a high volume tertiary care medical center to gain a breadth of experience in obstetrics. Our fundamental belief is that maternity care is an important part of family medicine residency training, and that family medicine residents should learn it from both obstetricians and family physician faculty. This commitment means that you will follow your own maternity patients at the CHA Malden Family Medicine Center and do your own deliveries and postpartum care with family practice attendings. A large number of Tufts family medicine faculty provide maternity care.

At the end of your first year of residency you and your classmates will take the award winning AAFP course, Advanced Life Support in Obstetrics that focuses on prenatal emergencies, taught by local family physicians. As a second and third year resident you enhance the skills you developed in the first year in a second year rotation and your continuity deliveries.

Second year residents obtain two weeks of obstetrics experience at our Cambridge campus, an extremely busy community hospital site averaging over 1400 deliveries annually. All continuity maternity care patients will also be delivered at Cambridge. Your family medicine faculty along with very supportive community-based family physicians and obstetricians teach prenatal care, management of labor, deliveries, and postpartum care. You will round on normal and high risk patients, follow women in labor, and deliver their babies. This provides appreciation of both normal and complicated labor. You will also learn use of modalities such as ultrasound and nonstress testing and assist at caesarian sections. Weekly teaching conferences at the residency site enhance your learning. Residents interested in training to competency level in obstetrics typically use some of their elective time to pursue other high-volume obstetrical training in a variety of local, national and international settings.

Orthopedics and Sports Medicine

Our orthopedic and sports medicine curriculum focuses on what you need to know as a primary care physician. During your orthopedic rotation as a second year you join orthopedic surgeons, casting techs, and physical therapists in the office to learn hands on diagnostic and therapeutic techniques. In your third year our sports medicine experience is longitudinal with our Primary Care Sports Medicine faculty in our family medicine clinic. Additionally you will do community outreach at Malden High School with student athletes and their athletic trainer. You will participate in injury clinics, rehabilitation, counseling, sport related concussion evaluation/management, pre-athletic screening services for Malden High School, and sideline coverage for Malden High School, Professional sports teams, and community events. The time spent with patients and in the community is complemented by our longitudinal curriculum taught by our Primary Care Sports Medicine Specialist. When you graduate you will be comfortable in musculoskeletal diagnosis, treatment, and procedures for primary care practice as a resident and beyond.

For those interested we have a sports medicine area of concentration learning track. Our primary care sports medicine physician graduated from UConn’s fellowship and will prepare you for an excellent sports medicine fellowship. Previous residents have done sports medicine fellowships at top locations such as UMass.

Pediatrics

There is no better example of the benefit of our location and our ability to offer residents the best of both worlds than in Pediatrics. First year residents spend six weeks on an inpatient Pediatrics team at Tufts Medical Center’s Floating Hospital for Children in Boston. The quantity and diversity of clinical problems encountered make this an exceptional experience not ordinarily found in community hospital-based residency programs. Supervised by third year Pediatrics residents and pediatrics attending teaching faculty, you have direct responsibility for patient care. First year residents also spend two weeks in the Floating Hospital's newborn nursery, developing expertise in care of newborns as well as performing neonatal resuscitation in the delivery room. You attend the teaching rounds, conferences, and seminars of this outstanding pediatrics residency at Tufts Medical Center.

Because most care of children is done as an outpatient however, experiences in community-based pediatricians' offices is essential. We have a second year rotation working with our Cambridge Health Alliance pediatrician colleagues. We also enjoy a robust (20%) population of pediatrics in our own Malden Family Medicine Center. A regular series of didactics presented by pediatricians and family physicians complete your experience.

Practice Management and Executive Skills

We believe that in today's climate of health reform and change should not longer be focused on training virtuoso violin player physicians, but today's needs call for highly trained orchestra conductors that are capable of creating and managing a highly functioning clinical team. Since our curriculum is centered on our family medicine center, residents become well versed in the process improvement techniques as we strive for continual quality improvement and better patient centered care. Didactics and experiential learning (e.g. serving on improvement committees and facilitating your clinical teams) give you the executive skills you’ll need to lead the primary care transformation spreading across the country.

Psychiatry/Behavioral Medicine

Cambridge Health Alliance boasts one of the best integrated primary care – psychiatric/ behavioral health services in the nation. As a first year resident you rotate with a number of our services including our psych emergency room, adult and child psychiatry, behavioral health and addictions. In our own family medicine center we have broad services including adult and child psychiatry, counseling, behavioral medicine including biofeedback and hypnosis. We aim for highly collaborative care so our patients can easily get the mental health care they need in the primary care environment they are comfortable with.

As a second year resident you will attend a week-long course with your classmates in "Clinical Training In Behavioral Medicine" at the Mind/Body Medical Institute of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. Here you will learn valuable skills you w can use virtually every day to help patients in your practice.

Resident Conferences

The Tufts University Family Medicine Residency has an unusually extensive series of resident conferences, held five days weekly in the residency's Conference Room. Speakers include both family physicians and sub specialists from Tufts and other Boston institutions as well as Cambridge Health Alliance. You will also attend the weekly hospital Grand Rounds which feature nationally- known speakers from Boston and throughout the country. Journal Club and Evidence-Based Medicine seminars are also held monthly at which all residents and faculty discuss and evaluate articles from the recent medical literature. Rotation-specific conferences when on Boston rotations round out your didactic experience.. Because residency can be stressful, and learning to be a doctor stretches all of us we also have conference time set aside for support group and professional development aimed at helping you find your path in this career. Throughout your three years your faculty advisor will meet with you individually to review your progress and support your development. Furthermore, there is regular review and feedback provided by each rotation supervisor based on performance standards. You will also have regular formal reviews of your overall progress each year. Our residents play an integral role in assessment of our residency program's training experiences.

Resident Research

Tufts is recognized as one of the leading research universities in the United States. The Department of Family Medicine and Community Health has an active and productive research faculty who are involved in a broad range of research activities. These include the development of alternative approaches to the prevention of illness and the delivery of health care, nutrition, investigations into methodologies for the analysis of clinical and epidemiologic data, and health policy. For example, research on improving health delivery includes studies on adolescent obesity, public policy on lead poisoning prevention, and tobacco control. Also, the Family Practice Research Network (ReNet), in conjunction with the Massachusetts Academy of Family Physicians, provides the basis for intradepartmental collaboration among residency programs. Research is done in Boston and the Malden campuses.

Cambridge Health Alliance research arm is the Center for Community Health which is a public health research institution doing community based participatory research (CBPR) and other techniques to help promote and study public health in our communities.

Surgery

During your general surgery rotations the emphasis is on pre-operative and post-operative evaluation and care. Operating room experience in a community hospital setting, working with enthusiastic community-based surgeons provides a great deal of hands-on experience. Without the hierarchy of a tertiary medical center, you will be allowed to do a great deal of assisting at surgery with expert supervision. You work up new patients, write orders in the hospital in consultation with your attending physician, and attend surgical conferences. You evaluate surgical emergencies and learn office-based surgery, in the surgeons' office and at the Malden Family Medicine Center. Many residents also elect to do an additional emergency medicine month in either a community hospital or tertiary setting.